Health sector in need of digitalisation

The Maldives faces a daunting challenge in ensuring sustainable access to health services equitably throughout the country. While access to basic health care is a right for all citizens, the establishment of full-care hospitals in each island is impossible, given the small population sizes in some islands. Geographically dispersed islands with a lack of adequate health facilities leaves residents no choice but to travel the nearest island with a hospital or to capital Malé for health care. There is also the preference for locals to travel to neighboring countries such as India and Sri Lanka to avail health care services, combined with a vacation. 

The Maldives has been slow to embrace the efficiencies of information technology in the provision of health care. Vice President Faisal Naseem reiterated at the 2019 Maldives Partnership Forum that the government was pursuing digitalization of the healthcare sector through a unified healthcare system, where the government proposed establishing a telemedicine component to address the geographic gaps in accessing affordable and sound health care. The Ministry of Health in its 'Health Master Plan 2016 – 2025' identifies telemedicine as a potential tool in developing mechanisms for remote diagnosis in conjunction with effective sample transport, image transfer and other telemedicine technologies. However, the question remains as to how much has been achieved in order to successfully implement these initiatives. 

Telemedicine, although not a mainstream form of patient interaction, has been rising in acceptance for years now. Telecommunications and medicine are combined to assist doctors in the exchange of information, such as sending X-rays, in electronic forms to seek specialist opinions. While this is increasingly common in today’s world, further improvements in Telemedicine are exploring a new paradigm – patient-doctor models where patients can consult doctors over a video link. Adapting to such digital technologies in health care can easily provide access to basic health care and treatment for routine diseases remotely, whilst simultaneously reducing the cost of treatment. 

Efforts had been made earlier to introduce telemedicine in the Maldives. The first telemedicine project was recorded in 2002; the Health Telematics Project funded by the World Health Organization. However, the project did not materialize as planned due to administrative and logistical issues. The World Bank-funded Integrated Human Development Project (HDP) two years later also had difficulties in implementation due to technical issues, failure to achieve project management deadlines, as well as inefficiencies in internet bandwidth across the nation.

In 2010, funded by the Khalifa Bin Zayed Al Nahyan Foundation, the Ministry of Health implemented the Medical Kiosk project, which was better planned and organized compared to earlier projects. The project aimed to deliver telemedicine kiosk carts and additional equipment at 35 locations, including 32 remote islands. Speaking to MFR, Dr. Ibrahim Yasir Ahmed, Medical Director of Medica Hospital and Senior Consultant in Internal Medicine, highlighted that the project included healthcare human resource development through overseas training as well as procurement of the Medical Kiosk hardware. However, the project eventually came to a standstill after only managing to train the specialists and procurement of the hardware, due to political and administrative changes.

The success rate of telemedicine projects has been incredibly low, with initiatives failing to take traction after millions or billions are invested in it. Studies show that more than 75 percent of telemedicine initiatives fail during the operational phase, which stands true in the Maldivian context as well. 

However, strengthening the local health care system and adapting digital technologies to meet increasing demands for health care became prominent during the COVID-19 pandemic. Travel restrictions exposed limitations in the provision of health care, while demand for telehealth services increased. In November 2020, Ooredoo Maldives partnered with Sri Lanka's oDoc telemedicine platform to provide certain health care services electronically. Hospitals switched to online consultations for non-covid patients, as in-house consultations were considered unsafe with the high risks of contracting the COVID-19 virus. 

Medica Hospital carried out a telemedicine survey in 2020, aimed at determining the feasibility and resultant patient satisfaction from teleconsultations. From 706 consultations across eight specialties, ninety patients were selected for the survey. Of the survey respondents, 63 percent said they were very satisfied with the service, and all participants expressed willingness to continue utilizing teleconsultations from Medica Hospital post-pandemic. The survey indicated that telemedicine was seen a viable technology by locals. 

According to Dr. Yasir, many patients from the islands do not consider teleconsultations as it is not covered under Aasandha. The patients who do use the services have said that it is less costly, as it does not require travel all the way to Malé. However, for the majority of patients, the service is not affordable without Aasandha coverage. 

Wider adoption of telemedicine in a country such as the Maldives will reduce the need to travel to Malé or abroad for medical treatments, while simultaneously promoting the use of electronic medical records. The country's current medical system is overwhelmingly paper-based, patients carrying a file of medical history documents for each hospital visit. While some hospitals and clinics have digitized patient records and data, these proprietary systems are incompatible, resulting in duplicate procedures and data. This will, however, require a country-wide, government-led system given the privacy implications of having a central system. 

The path towards implementing telemedicine is not entirely smooth. Despite the need and existence of technology, many hurdles remain, including the lack of digital platforms to conduct tele-visits, the legal frameworks required to ensure privacy of patient data, as well as the need for affordable, high quality broadband access. There also exists a limit to the prospective use of telemedicine in that it lacks the ability to conduct physical examinations where needed, the deep human interactions sometimes required and the transmission of empathy and trust during consultations. However, it is a vital technology that may be used in follow up consultations, requesting medicine prescriptions and consultations for common diseases from the comfort of the patient’s home.

Reflecting on lessons leant from previous attempts, Dr. Yasir says that future projects must be implemented at national level, involving the Ministry of Health and other stakeholders, including the Aasandha Company. A project that is backed by viable feasibility studies diagnosing any hurdles to implementation and aligned with strategic goals and robust plans that will not be paused by the changes in government administrations. The digitalization and use of ICT in health sector of Maldives will transform the lives of all citizens.